CPT/HCPCS Codes J3490* Testosterone pellets (Testopel®) 11980* Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) * Providers must bill HCPCS code J3490 and CPT code … Each sterile pellet weighs approximately 78mg (75mg testosterone) and is ready for implantation. Thread starter jdeland; Start date May 19, 2017; J. jdeland Guest.

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Are we able to bill for the number of pellets that we reinsert and the implantation fee? For a better experience, please enable JavaScript in your browser before proceeding. Based on the guidelines included in our revised medical policy, Implantable Testosterone Pellets (Testopel® Pellets), AND the submitted diagnosis or diagnoses code(s): CPT® code 11980 and/or HCPCS code S0189 CPT Code Description 11980 ... J3490 Unclassified drugs (Testopel®) ICD-10 Diagnosis Code Description D35.2 Benign neoplasm of pituitary gland D44.3 Neoplasm of uncertain behavior of pituitary gland E23.0 Hypopituitarism E23.1 Drug-induced hypopituitarism He had procedure done on 4/27/17 and we received a message on 5/11/17 that some of the pellets have fallen out. Injectable testosterone pellets (brand name Testopel™) may be covered, by Medicare, for the FDA approved indication, if the service meets all Medicare coverage requirements quoted below verbatim in the Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.3.2. Injection Method Not Indicated The administration code is CPT 11980.

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Testosterone is actively marketed as administered topically or orally for frequent use by the patient, according to Marlene Doty, CPC, CUC, PCS. Request a TESTOPEL ® sales representative.

CPT1 (Procedure) Code 11980 Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) HCPCS Code (Private Insurance) S0189 Testosterone pellet, 75 mg HCPCS Code (Medicare) J3490 Unclassified drugs NDC Code (For Medicare claims except CA and NV) 43773–1001–03 100‐count box. Please use codes that most accurately reflect the procedures performed. We have a patient that gets Testopel pellet implantation. He had procedure done on 4/27/17 and we received a message on 5/11/17 that some of the pellets have fallen out. He had procedure done on 4/27/17 and we received a message on 5/11/17 that some of the pellets have fallen out. If anyone has feedback, Id greatly appreciate it, as I'm doing CCS prep now.

We have a patient that gets Testopel pellet implantation. The drug name and total dosage must be indicated in the documentation record for EDI claims and Item 19 of paper claims. Thanks ! We use ICD-9 codes 257.2 and 607.82.

Are we able to bill for the number of pellets that we reinsert and the implantation fee? TCI’s vision is to deliver innovative healthcare solutions and knowledge to our customers worldwide. Please use codes that most accurately reflect the procedures performed. HCPCS Code: S0189. Will get back to you soon.
! By clicking this link, you'll be leaving TESTOPEL CPT1 (Procedure) Code: 11980: Subcutaneous hormone pellet implantation (implantation of testosterone pellets beneath the skin) HCPCS Code (Private Insurance) S0189: Testosterone pellet, 75 mg: HCPCS Code (Medicare) J3490: Unclassified drugs: NDC Code (For Medicare claims) 66887-004-20 (10-digit) 66887-0004-20 (11-digit) 100‐count box. of pellets c. The National Drug Code number. Since you have not mentioned the procedure code, considering that your code has a global period of 10 days and the patient has been seen within the global period, you need to append modifier 78 to the procedure code suggesting that this was an unplanned return to the operating room in the post … You have clicked on a link intended for US healthcare professionals only.In order to download this Reimbursement Tool, you must be a US healthcare professional.

No. Thanks for you question.

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Don’t sacrifice your valuable time to endless research. each pellet is 75 mg for a total of 1050 mg. What is all required information Medicare needs to process this charge. We bill 14 pellets. TESTOPEL ®: An In-office Procedure Completed in Approximately 15 Minutes Getting started with TESTOPEL ® A healthcare provider at your doctor’s office implants TESTOPEL ® pellets just under the skin in the hip area or another fatty area.
Choose Ask an Expert to get clear answers from the TCI SuperCoder team. I do not know the exact amount of reimbursement for 2014 as I am watching for an eob as we speak.

Hope this helps,good luck.

Have a medical coding or compliance question? If this is your first visit, be sure to check out the JavaScript is disabled. You must log in or register to reply here.

To reach the TESTOPEL ® Reimbursement Program, please call 1–800–897–9006, Monday–Friday, 8 AM to 7 PM ET. Suggestions by Endo Pharmaceuticals Inc. do not gurantee reimbursement or take the place of professional coding advice. Thanks !

CPT 11980 is reimbursed at $96.39 per 2014 fee schedule and J3490 was reimbursed at $77/pellet 4th quarter of 2013. The NDC product code may vary.

Global period of the minor surgical procedures is usually 10 days. Use the unlisted J code in the first line of the procedure code section (box 24), along with "one" unit and the full price to be charged. Provides healthcare professionals with an essential overview of TESTOPEL ®, including details on the in-office implantation procedure, dosing guidelines, and reimbursement.

Use the unlisted J code in the first line of the procedure code section (box 24), along with "one" unit and the full price to be charged.

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